Chapter 1
The challenges of a changing world
This chapter describes the context in which the contemporary renewal of primary health care is unfolding. The chapter reviews current challenges to health and health systems and describes a set of broadly shared social expectations that set the agenda for health systems change in today’s world. It shows how many countries have registered significant health progress over recent decades and how gains have been unevenly shared. Health gaps between countries and among social groups within countries have widened. Social, demographic and epidemiological transformations fed by globalization, urbanization and ageing populations, pose challenges of a magnitude that was not anticipated three decades ago.
In this chapter
- Unequal growth, unequal outcomes
- Adapting to new health challenges
- Trends that undermine the health systems’ response
- Changing values and rising expectations
- PHC reforms: driven by demand
Figures
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Selected best performing countries in reducing under-five mortality by at least 80%, by regions, 1975–2006
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Factors explaning mortality reduction in Portugal, 1960–2008
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Variable progress in reducing under-five mortality,1975 and 2006, in selected countries with similar rates in 1975
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GDP per capita and life expectancy at birth in 169 countries, 1975 and 2005
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Trends in GDP per capita and life expectancy at birth in 133 countries grouped by the 1975 GDP, 1975–2005
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Countries grouped according to their total health expenditure in 2005 (international $)
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Africa’s children are at more risk of dying from traffic accidents than European children: child road-traffic deaths per 100 000 population
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The shift towards noncommunicable diseases and accidents as causes of death
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Within-country inequalities in health and health care
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How health systems are diverted from PHC core values
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Percentage of the population citing health as their main concern before other issues, such as financial problems, housing or crime
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The professionalization of birthing care: percentage of births assisted by professional and other carers in selected areas, 2000 and 2005 with projections to 2015
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The social values that drive PHC and the corresponding sets of reforms
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